Anxiety sensitivity (AS) is associated with health behaviors such as low rates of physical activity, overeating, alcohol use, and poor sleep; however, interventions targeting AS via exercise-based interoceptive exposure have not assessed these as outcomes. In addition, previous studies are limited by brief follow-up periods. This study aimed to replicate previous aerobic exercise interoceptive exposures with an extended (6-week) follow-up and measurement of health behaviors. Participants were 44 sedentary young adults with elevated AS randomized to intervention (6 20-minute sessions of moderate-intensity treadmill walking) or assessment-only control. Assessments took place at baseline, week 2 (post-treatment), week 4, and week 8 with measurements of AS (ASI-3), physical activity (7-Day PAR), sleep (ISI), binge eating, alcohol use, depression (PHQ-8), anxiety (GAD-7), and stress (PSS-4). The intervention condition demonstrated a marginally significant reduction in AS compared to control at week 4 which eroded by week 8. There were no significant between-group differences for health behavior change. The intervention condition demonstrated decreases in depression, general anxiety, and perceived stress compared to control, but these effects eroded by week 4. There was no difference in findings for participants with BMI<25 vs. those with BMI>=25. Findings indicate that a brief intervention might not be sufficient to produce lasting changes in AS without additional treatment. Intervention effects were not as strong in this study compared to previous reports, which may be due to the size and greater racial/ethnic diversity of the current sample. Future research should objectively measure physical activity and explore individual variability in treatment response.

Anxiety sensitivity, defined as the fear of anxiety-related sensations and their consequences (Reiss & McNally, 1985), has been consistently shown to be associated with risk for anxiety psychopathology as well as other mental health problems. The primary objective of the present secondary prevention trial sought to examine strategies to reduce anxiety sensitivity among persons with elevated anxiety sensitivity by testing the singular and combined efficacy of two commonly used strategies in multi-component interventions for reducing anxiety sensitivity: (a) anxiety psychoeducation emphasizing the benign nature of stress and (b) interoceptive exposure (i.e. repeated inhalations of 35% CO₂ gas mixture). To provide a stringent control for non-specific effects associated with anxiety psychoeducation and interoceptive exposure with CO₂, two control strategies were included in the study design: general health and nutrition education and repeated inhalations of regular room air. Utilizing a 2X2 design, participants were randomly assigned to receive an education component and intervention sessions consisting of one of two gas mixtures. The current study did not support the relative efficacy of hypothesized active intervention strategies. Rather, all conditions led to significant reductions in anxiety sensitivity. In addition, within-condition effect sizes for conditions in the present study were comparable to effect sizes of active interventions that were efficacious in previous research. Findings from the present study support that anxiety sensitivity is malleable following brief, cost-efficient interventions and these reductions are maintained over a one-month follow-up period. Data from the present study suggest that in the presence of stringent control conditions, hypothesized active intervention strategies provided little additional benefit. The present study has implications for methodological considerations for future secondary prevention trials for the reduction of anxiety sensitivity. The absence of stringent control groups might lead to premature conclusions that reductions in anxiety sensitivity are due to the specific effects of active interventions. Further research is needed to elucidate specific effects of intervention strategies for the reduction of anxiety sensitivity in at risk populations in order to refine secondary prevention interventions aimed to reduce risk for psychopathology. / text

Anxiety Sensitivity (AS), the belief that anxiety-related sensations may have harmful implications, can alter autonomic nervous system (ANS) function. Exercise has previously been shown to reduce AS; however, the effects of an exercise intervention on heart rate variability (HRV), a measure of ANS function, has not been evaluated in individuals with high AS. This study sought to 1) compare resting HRV in individuals with either low (LAS) or high AS (HAS) and 2) evaluate the effects of a 2-week exercise intervention on HRV and AS. Using the Anxiety Sensitivity Index (ASI-3), participants were identified as LAS (n=9; ASI-3=5.89±1.39) or HAS (n=15; ASI-3=32.87±2.49) and subsequently completed six 20-minute moderate intensity exercise sessions. HRV and psychosocial measures were obtained at baseline and following the 2-week intervention. No significant differences (p>0.05) in time or frequency domain HRV values between groups were revealed at baseline; however, when considering the HAS group alone, strong associations were observed between the ASI-3 score and HRV values in the time domain: RMSSD (r=-0.56), SDNN (r=-0.61), and pNN50 (r=-0.53). Following the intervention, changes observed in HRV and the higher and lower order (subscale) ASI-3 scores were not different between the groups; however, a medium to large effect was observed for the higher order ASI-3 and the cognitive subscale score, suggesting that our findings were likely limited by the small sample size. Further research is warranted to evaluate the relationship between HRV and AS and should seek to determine the most effective exercise interoceptive exposure for improving AS symptomology.

<p>Aktuell forskning har visat att psykologiska faktorer spelar en viktig roll för upplevelsen av långvarig smärta. Denna studie undersökte effekterna av en KBT-behandling bestående av introceptiv exponering och avslappning för patienter med långvarig smärta. Studien använde en single-subject design där sex smärtpatienter genomgick en sex veckor lång individuell behandling. De variabler studien undersökte var i första hand förändringar gällande grad av acceptans samt upplevd smärtintensitet, i andra hand förändringar gällande smärtrelaterad ångest, rörelserädsla, katastroftankar samt funktion. Deltagande i behandlingen var förknippat med ökad acceptans, förbättrad funktion, minskad smärtintensitet, minskad smärtrelaterad ångest, mindre katastroftankar samt minskad rörelserädsla. Studien tyder på att denna behandling kan leda till positiva förändringar hos smärtpatienter för såväl kognitiva och känslomässiga komponenter som beteendemässiga komponenter.</p> / <p>Current research has shown that psychological factors play an important role in the experience of chronic pain. This study examined the effects of a CBT treatment containing interoceptive exposure and relaxation for patients with chronic pain. The study used a single-subject design where six patients underwent a six week long individual treatment. The variables the study examined were changes concerning degree of acceptance, pain intensity, changes concerning pain related anxiety, kinesiophobia, catastrophizing and function. Participation in the treatment was associated with increased acceptance, improved function, reduced pain intensity, reduced pain related anxiety, less catastrophizing and reduced kinesiophobia. The study indicates that this treatment can lead to positive changes with pain patients in both cognitive and emotional components as well as behavioral components.</p>

Aktuell forskning har visat att psykologiska faktorer spelar en viktig roll för upplevelsen av långvarig smärta. Denna studie undersökte effekterna av en KBT-behandling bestående av introceptiv exponering och avslappning för patienter med långvarig smärta. Studien använde en single-subject design där sex smärtpatienter genomgick en sex veckor lång individuell behandling. De variabler studien undersökte var i första hand förändringar gällande grad av acceptans samt upplevd smärtintensitet, i andra hand förändringar gällande smärtrelaterad ångest, rörelserädsla, katastroftankar samt funktion. Deltagande i behandlingen var förknippat med ökad acceptans, förbättrad funktion, minskad smärtintensitet, minskad smärtrelaterad ångest, mindre katastroftankar samt minskad rörelserädsla. Studien tyder på att denna behandling kan leda till positiva förändringar hos smärtpatienter för såväl kognitiva och känslomässiga komponenter som beteendemässiga komponenter. / Current research has shown that psychological factors play an important role in the experience of chronic pain. This study examined the effects of a CBT treatment containing interoceptive exposure and relaxation for patients with chronic pain. The study used a single-subject design where six patients underwent a six week long individual treatment. The variables the study examined were changes concerning degree of acceptance, pain intensity, changes concerning pain related anxiety, kinesiophobia, catastrophizing and function. Participation in the treatment was associated with increased acceptance, improved function, reduced pain intensity, reduced pain related anxiety, less catastrophizing and reduced kinesiophobia. The study indicates that this treatment can lead to positive changes with pain patients in both cognitive and emotional components as well as behavioral components.

Anxiety sensitivity (AS; fear of anxiety-related bodily sensations) is a risk factor for anxiety and related psychological disorders. Preliminary evidence also associates high AS with reduced levels of physical exercise and fitness. The primary objectives of the five studies comprising this dissertation were 1) to further explore the relationships between AS levels and exercise/fitness levels, and 2) to evaluate outcomes and processes of a brief group cognitive behaviour therapy (CBT) that included a novel exercise-based interoceptive exposure (IE; exposure to feared anxiety-related sensations) component of running, with female undergraduate students. High AS female undergraduate participants endorsed more barriers to exercise than low AS participants, and these accounted for the inverse relationships between AS group and exercise/fitness levels (Study 1). The brief CBT/IE led to decreases in AS levels (Studies 2 and 4) and in symptoms of stress, depression, and anxiety (Study 4) for high AS participants. Processes involved in the brief CBT’s therapeutic effects were explored by examining cognitive (i.e., catastrophic thoughts), affective (i.e., feelings of anxiety), and somatic (i.e., physical sensations) reactions to the running IE component with an existing measure, the hyperventilation questionnaire (HVQ; Study 2), and a brief version of the measure, the HVQ-B, developed and validated in Study 3 (Study 5). Changes in cognitive and affective reactions to running were most closely associated with the brief CBT/IE’s therapeutic benefits, underlying the importance of changing the meaning of and emotional reaction to physiological arousal. Surprisingly, a health education control (HEC) intervention consisting of an interactive discussion on exercise, nutrition and sleep for health, including problem-solving barriers to health behaviours, also led to decreases in AS levels and in symptoms of depression and anxiety (Study 4). Physical exercise, the common link between the two interventions, may be partially driving the interventions’ therapeutic benefits. More specifically, perhaps both interventions addressed barriers to exercise, either by altering the meaning of and emotional reaction to exercise (CBT/IE), or through problem-solving (HEC). Encouraging physical exercise in high AS individuals by acknowledging and addressing barriers to exercise might help decrease these individuals’ AS levels and improve their overall mental health

Panic disorder (PD) and claustrophobia are commonly co-occurring anxiety disorders associated with high distress and impairment. Interoceptive exposure (IE; exposure focused on anxiety about somatic sensations) is a well-established component of treatments for PD, but little is known about the specificity of its effects or individual response patterns resulting from this intervention. This study investigated the utility of IE in the treatment of PD with claustrophobia, examining its mechanisms in isolation and in combination with more traditional exposure to phobic situations (situational exposure). Ten adults with PD and claustrophobia (aged 23-74, 30% female) were treated with a flexible single-case experimental approach. Participants received up to 6 sessions of IE exercises (e.g., running in place to build tolerance to racing heart). Nonresponders received up to 6 additional sessions of IE combined with situational exposure entailing entering a closet to induce claustrophobia. Hypotheses included: 1) Reductions in somatic anxiety coinciding with the introduction of IE; 2) Reductions in agoraphobic symptoms coinciding with the introduction of situational exposure for initial nonresponders; 3) Habituation to both interventions whereby distress and participants’ expectancy of the most feared outcome (e.g., fainting) would decrease, and fear tolerance would increase, with improvements maintained at retest. Four participants experienced a clinically significant reduction in somatic anxiety coinciding with IE as predicted; three other participants improved following the addition of situational exposure. One aspect of agoraphobic anxiety – willingness to enter enclosed spaces – generally improved only after combined exposure, as predicted. Both IE and combined exposure elicited habituation whereby distress and expectancies of feared outcomes decreased and fear tolerance increased, supporting hypotheses. All improvements were maintained at retest. Ideographic analysis suggested that IE can rapidly change beliefs about somatic sensations and lead to distress habituation, but has variable immediate effects on overall somatic anxiety and does not reliably reduce related symptom sets (e.g., agoraphobia). IE appeared more helpful to participants who were fearful of the physical consequences of somatic sensations (e.g., heart attack) vs. other consequences (e.g., embarrassment). The observed variability in response to IE and combined exposure suggests a need for individualized implementation of treatments in PD with claustrophobia.

Hintergrund: In der Kognitiven Verhaltenstherapie (KVT) der Panikstörung mit Agoraphobie (PD/AG) werden häufig Körperübungen zur Symptomprovokation (interozeptive Exposition) eingesetzt, jedoch liegen kaum systematische, empirische Untersuchungen zu Wirkung und Wirkweise dieser Übungen vor. Ziel der vorliegenden Studie war die Charakterisierung individueller Reaktionen auf interozeptive Übungen sowie die mit der Wiederholung der Übungen verbundenen Veränderungen dieser Reaktionen. Patienten und Methoden: Selbstberichtdaten zu ausgelösten Körpersymptomen sowie Symptom- und Angststärken von 301 Patienten mit PD/AG, die verschiedene interozeptive Übungen durchführten, wurden ausgewertet. Die Durchführung der interozeptiven Exposition erfolgte im Rahmen einer manualisierten KVT des Psychotherapieverbundes «Panik-Netz». Ergebnisse: Interozeptive Exposition löste Körpersymptome und damit verbunden Angst aus. Am häufigsten wurden vestibuläre, respiratorische und kardiovaskuläre Symptome ausgelöst. Die stärkste Symptomausprägung verbunden mit der stärksten Angst erzeugten die Übungen «Drehen», «Hyperventilieren» und «Strohhalmatmung». Übungswiederholung bewirkte eine Reduktion der Symptom- und Angststärken, insbesondere die Übungen «Drehen», «Strohhalmatmung» und «Hyperventilieren». Diskussion und Schlussfolgerungen: Interozeptive Exposition ist gut geeignet zur Auslösung von Körpersymptomen und zur Reduktion der damit verbundenen Symptom- und Angststärke, insbesondere über die Übungen «Drehen», «Hyperventilieren» und «Strohhalmatmung». Zur größeren Angst- und Symptomstärkenreduktion empfiehlt sich eine hohe Wiederholungsrate. Die Relevanz respiratorischer, vestibulärer und kardiovaskulärer Symptome für den Behandlungserfolg sollte weiterführend untersucht werden. / Background: Although interoceptive exposure is a frequent component of cognitive-behavioral therapies (CBT) in panic disorder with agoraphobia, there is a lack of evidence investigating the effect of this treatment component and its underlying mechanisms of change. The present study aimed at characterizing individual responses to interoceptive exposure and response changes after repeated exposure. Patients and Methods: Under the national research initiative ‘Panic Net’, self-report data were analyzed including bodily symptoms, symptom intensity and experienced anxiety during interoceptive exposure of 301 PD/AG patients who participated in a manualized CBT trial. Results: Interoceptive exposure induced bodily symptoms and anxiety. Respiratory, vestibular and cardiovascular symptoms were most frequently reported. Spinning, breathing through a straw and hyperventilation produced most intense symptom reports and anxiety ratings. Repeating the interoceptive exposure reliably reduced reported symptom intensity and anxiety ratings particularly after spinning, breathing through a straw and hyperventilation. Discussion and Conclusions: In PD/AG patients, interoceptive exposure induces bodily symptoms and reduces reported symptom intensity and anxiety, particularly through spinning, hyperventilation and breathing through a straw. Repeated rehearsal is encouraged given that larger reduction of anxiety and symptom reports were associated with more training. Further research is needed to assess the relevance of respiratory, vestibular and cardiovascular symptoms for CBT treatment.

Objectives: Patients with Panic Disorder (PD) show an abnormal stress-induced functioning of the Hypothalamic-Pituitary-adrenal (HPA)-axis. Different protocols for stress induction are of rather low relevance for the psychotherapeutic treatment. In practice, interoceptive exposure is often realized as Low Intensity Exercise (LIE), as compared to an incremental cycle exercise test to exhaustion. Currently, it is not known, whether LIE displays an effective interoceptive stressor 1.) leading to a significant anxiety induction; 2.) a comparable HPA- and Sympathetic-Adreno-Medullar (SAM)-axis response in both patients and healthy controls; 3.) stress responses under LIE are associated with treatment outcomes. Patients and methods: N = 20 patients with PD and n = 20 healthy controls were exposed to ten minutes of LIE on an exercise bike. LIE was applied as part of the interoceptive exposure, during an intensive Cognitive-Behavioral Therapy (CBT) in a day clinic. Heart rate was monitored and salivary cortisol samples collected. Before and after the LIE, state anxiety/ arousal were assessed. In order to evaluate psychopathology, the Panic and Agoraphobia Scale, Mobility Inventory, Agoraphobic Cognitions Questionnaire and Body Sensations Questionnaire were applied, before (T1) and after five weeks (T2) of an intensive CBT. Results: LIE led to a significant and similar heart rate increase in both groups. Cortisol decreased over time in both groups, especially in male patients. A higher psychopathology before, and after CBT, was associated with a significantly lower cortisol response under LIE. Conclusions: In the present study, LIE led to a divergent stress response: while there was a significant heart rate increase, cortisol decreased over time, particularly in male patients. A lower reactivity of the HPA-axis seems to be associated with a lower treatment outcome, which may affect extinction based learning. The findings suggest, that interoceptive stimuli should be designed carefully in order to be potent stressors.